Objective: To identify functional neuroimaging patterns anticipating the clinical indication for deep brain stimulation (DBS) in patients with PD.

Background: DBS has become a well-established neuromodulating treatment for PD. Currently, indications to DBS are based on some general and clinical features. Biomarkers that predict indication to DBS treatment and its clinical response are still largely lacking.

Method: PD patients performed clinical and cognitive evaluations and resting-state functional MRI (RS-fMRI) at baseline and every year for 4 years. Patients were divided into two groups: 19 patients eligible for DBS (PD-DBS) over 48 months and 41 patients who did not meet the criteria to undergo DBS surgery (PD-noDBS). 60 age- and sex-matched controls performed baseline assessments. Graph analysis and connectomics assessed global and local topological network properties and regional functional connectivity (FC) at baseline and changes over-time.

Results: Network analysis showed a higher mean nodal strength, local efficiency and clustering coefficient of the occipital areas in PD-DBS relative to both controls and PD-noDBS at baseline. The occipital hyperconnectivity pattern was confirmed also by regional functional connectivity analysis. Contrarily, a significantly decreased functional connectivity between basal ganglia and sensorimotor/frontal networks was found in PD-DBS compared to PD-noDBS patients at baseline. In the longitudinal analysis, PD-DBS patients showed a progressive decreased topological brain organization and functional connectivity, mainly in the posterior brain networks, and a progressively increased connectivity of basal ganglia network compared to PD-noDBS.

Conclusion: Baseline occipital hyperconnectivity in PD-DBS patients was related to tremor severity at baseline and over time. Specific RS-fMRI features, such as occipital hyperconnectivity and basal ganglia-sensorimotor/frontal hypoconnectivity together with the progressive reshape of these same networks, could be potential red flags in favour of DBS procedure in PD patients. RS-fMRI may support the clinical indication to DBS and could also be useful in predicting which patients would be eligible to undergo DBS in the earlier stages of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/functional-connectivity-as-an-early-marker-of-indication-for-deep-brain-stimulation-treatment-in-parkinsons-disease-pd/